Tuesday, March 31, 2015

Obesity Can Kill Me? What Could Be Worse!?

Early in my career, I worked on claims against the Florida Special Disability Trust Fund. In the days before the Americans with Disabilities Act (ADA) there were efforts to encourage employers to hire those with pre-existing medical concerns. These "second injury funds" were designed to soften the financial impact on the employer of a workplace accident if some pre-existing condition contributed to the resulting disability or need for treatment. Florida has sunset its Fund, as have other states to varying degrees. 

How do these funds work? In Florida, the conditions that might qualify were listed in the statute, Fla. Stat. 440.49. The list included a variety of potentially serious medical conditions such as diabetes, Parkinson's diseases, cardiac disease, and more, One on that list that surprised many was obesity. It may be that surprise was influenced by realization, such as my own, that the law was calling me obese. What the statute actually provided was:

Obesity if the employee is 30 percent or more over the average weight designated for her or his height and age in the Table of Average Weight of Americans by Height and Age prepared by the Society of Actuaries using data from the 1979 Build and Blood Pressure Study.

As a young lawyer, I was surprised to learn that obesity was viewed in the same category with these other medical conditions. I looked-up that average weight and did the math. I found myself barely under the mark for the label "obese." Back then I did not consider myself obese, though in ensuing years I went through a weight gain that removed all doubt. When I was learning about the SDTF, we had not yet heard the national cacophony on obesity. 

That national focus has come in the last 25 years. We have heard and learned a great deal, particularly in the last decade or so, about obesity and the health risks that are associated with it. It is somewhat comforting to know that Florida had recognized the seriousness of obesity in the SDTF statute before it became a national focus. I wish I had recognized it earlier myself. 

Now we face a "national obesity epidemic." A recent post on Jon Gelman's blog cites to Kaiser Health News. It notes that as obesity increased in particular populations, the incidence of "chronic diseases" also increased. They note that this trend is worrisome. And that "one out of every three adults in the U.S. are clinically obese." Yes, that includes me, which means two of the rest of you are in the clear.

This reminds me of a quote from the beginning of The Paper Chase, which influenced a generation regarding attending law school. The protagonist there was giving the new law students a reality check when he said "look to your left, look to your right, because one of you won't be here by the end of the year." This analogy works with obesity, one in three. A staggering statistic.  

The Kaiser article notes potential for health complications that may be suffered by those of us that are obese. One cited study concluded that "obese people have higher health care costs." They note that obese people are heading into nursing homes at younger ages, and that there is added expense associated with care "for heavier residents."

Not shocking news, I grant you. The last 25 years have seen a variety of reports, publicity and news trying to convince us all to lose a few pounds. We as a nation are obsessed with weight. The "annual revenue of the U.S, weight-loss industry" is about $20 billion dollars. So, it is a problem that has gained recognition, and is receiving focus. Whether I individually will prevail in my own little battle of the bulge is up to me though. Some days I feel I am winning and other days I surrender to the sweet lure of chocolate.

With this backdrop of the seriousness of obesity, I was surprised to run across a headline trumpeting another recent study. In February 2014, the Guardian announced Loneliness Twice as Unhealthy as Obesity for Older People, Study Finds. The conclusion is that "a long-term feeling of extreme loneliness can have a worse impact on increasing potentially lethal health risks than obesity."

The study found that "chronic loneliness increases the risk of premature death by 14%." This was compared to obesity. The study concludes that loneliness increases the risk of premature death twice as much as the increase caused by being overweight. This is perhaps worrisome. As a side note, worse than either obesity or loneliness is poverty, which increases the risk about 19% according to this study. So being poor increases risk the most, then loneliness, then obesity. 

I wondered, as I read that, what that means for those who suffer all three, poverty, loneliness and obesity? Not an encouraging thought.

The authors claim that this loneliness finding portends a "crisis as the population ages and people increasingly live alone or far from their families." The Guardian discusses this recent study and cites previous studies that are supportive of their conclusions. It says that loneliness has been implicated in "a range of health problems, from high blood pressure and weakened immune system to a greater risk of depression, heart attack and strokes." Serious concerns. 

One author of the Guardian story suggests that individuals need to protect themselves from the threats presented. He suggests that remaining engaged in a community has merit and benefit. He advocates taking "time to enjoy yourself and share good times with family and friends." 

But, these are not infallible solutions. The study found some people "suffered the impacts of loneliness even with family and friends close by." Likewise, the "researchers found that some people were happy living a life of solitude." It may be that the impact depends somewhat on how the particular individual feels about the solitude or the companionship.  

One solution to both of these issues may be to find a social environment in which to exercise. I have tried for years to make exercise part of my daily routine. My continued obesity tells you my success has been limited. However, perhaps the solution is not a quiet, i-pod ensconced treadmill walk, but instead some engagement in a group social activity? At my age, I am not advocating touch football. But perhaps there is merit in the idea of group exercise class or a walking partner? 

While it does nothing for the biggest threat, poverty, perhaps it helps us with the other two? Besides the fact that I am perhaps more likely to exercise with company than alone. 

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